Organizational consequences of staff turnover in outpatient substance abuse treatment programs

The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. The sample consisted of 353 clinical staff from 63 outpatient agencies. Two scales from the Survey of Organizational Functioning measured work environment demands (stress and inadequate staffing), and 3 measured supportive work relationships (communication, cohesion, and peer collaboration). Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work environment demands but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands, decreases perceptions of support, and underscores the need to reduce stress and minimize subsequent turnover among clinical staff.     

Integrating spiritual and Western treatment modalities in a Native American substance user center: provider perspectives

Few studies examine how traditional Native American and Western healing practices are being integrated in Native American substance user treatment centers. Data are presented from a 2008 study of providers of integrated substance user treatment for Native Americans at an urban Western US center. Nineteen semistructured interviews were conducted to examine 10 providers' views of the integration of traditional and Western healing and the impact on recovery for clients. We used a grounded theory approach to data analysis with manual and NVivo codes and themes developed. Limitations and implications for practice are discussed.     

The contribution of consensus within staff and client groups as well as concordance between staff and clients to treatment engagement

Two nonspecific organizational factors-consensus, defined as agreement within staff and client groups, and concordance, defined as agreement between staff and client groups-were shown to influence client engagement in treatment in a national sample of 80 residential substance abuse treatment programs including 595 staff and 3,732 clients. Agreement was tested using a combined therapeutic community, cognitive-behavioral therapy, and 12-step treatment scale completed by staff and clients. Treatment engagement was measured by the combined scores on the three scales completed by the clients, including engagement, rapport with the counseling process, and confidence in treatment. Within-group consensus was measured by the standard deviations of the mean scores, whereas between-groups concordance was measured by the standard error of the difference between staff and client mean scores. Regression analyses showed that staff consensus was a significant independent predictor of client treatment engagement (p < .05), whereas client consensus approached significance (p < .10). Concordance was also a significant predictor of client engagement (p < .002) after controlling for staff and client consensus. The potential contribution of the findings to a better understanding of program quality and effectiveness of programmatic interventions is discussed.     

Jail-based substance user treatment: an analysis of retention

Many jail inmates have a history of substance use and "abuse"; few, however, receive comprehensive treatment for substance use disorders while in jail. The authors offer a longitudinal reanalysis of data from five jail-based substance user treatment programs. Survival analysis was used to identify client characteristics associated with length of time in treatment. Survival curves for the five programs were compared, indicating which ones retained inmates the longest. Results from a model stratified by jail site revealed that inmates over 25 years of age and those already sentenced had significantly longer treatment stays. The Substance Abuse Intervention Division (SAID) program, a modified therapeutic community in a New York jail, and the Deciding, Educating, Understanding, Counseling, and Evaluation (DEUCE) program, a curriculum-based intervention, had the longest survival curves and were, therefore, most effective at retaining inmates in treatment.     

Service user involvement in drug treatment programmes: Barriers to implementation and potential benefits for client recovery

Service user forums have the potential for improving awareness of services, empowering service users and strengthening community partnerships within an inclusive treatment and rehabilitation framework. The research aimed to investigate perspectives about service user involvement in order to inform the development of effective service user forum(s) in west Ireland. A total of 30 interviews with key service providers and 12 interviews with service users were conducted, with interview questions focusing on: (1) awareness of the Service User Support Team and (2) barriers to service user involvement and the development of service user forums in the region. An integrated data collection and thematic analysis was undertaken. Current levels of service user involvement were low, restricted by one-way communication and appeared grounded in user-provider power differentials and stigma relating to drug dependency. Service providers queried the actual terms of reference, capacity and training that would be needed for service user forums to advocate and lobby for service users. The use of existing support groups, creation of internet user forums and rotation of rural meetings were recommended to promote engagement among service users. The research underscores the need for transparency, resources and a framework for good practice that reflects a participatory approach.     

Program structure, staff perceptions, and client engagement in treatment

A key goal of drug abuse treatment providers is getting their clients to engage and participate in therapeutic activities as a first step toward deriving longer-term benefits. Much research had focused on personal characteristics that relate to client engagement; program characteristics have received less attention. This study explored client and program differences in engagement ratings using data from a nationwide set of 94 outpatient drug-free treatment programs in a hierarchical linear model analysis. The results show that elements of program context, including structural features (e.g., smaller size and Joint Commission on the Accreditation of Healthcare Organizations/Commission on Accreditation of Rehabilitation Facilities accreditation) and staff's perceptions of personal efficacy, organizational climate, and communal workplace practices, relate to better overall client engagement. These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality improvement efforts.     

Integrating HIV prevention into substance user treatment: current practices and challenges

Despite well-organized prevention efforts, HIV continues to spread in the United States. Injection drug users (IDUs) and other substance users who engage in high-risk behaviors are at particularly high risk for contracting HIV. Substance abuse(dagger) counselors therefore are in a unique position to present HIV prevention messages to their clients. This article reports the results of a study that surveyed counselors in an urban setting (n = 116) to assess their knowledge of HIV, their current HIV prevention practices, and their attitudes about integrating HIV prevention more fully into their work. The article concludes with a discussion of the survey's limitations and its implications for training.     

Contrasting faith-based and traditional substance abuse treatment programs

This article (a) discusses the definition of faith-based substance abuse treatment programs, (b) juxtaposes Durkheim's theory regarding religion with treatment process model to highlight key dimensions of faith-based and traditional programs, and (c) presents results from a study of seven programs to identify key program dimensions and to identify differences/similarities between program types. Focus group/Concept Mapping techniques yielded a clear "spiritual activities, beliefs, and rituals" dimension, rated as significantly more important to faith-based programs. Faith-based program staff also rated "structure and discipline" as more important and "work readiness" as less important. No differences were found for "group activities/cohesion" and "role modeling/mentoring," "safe, supportive environment," and "traditional treatment modalities." Programs showed substantial similarities with regard to core social processes of treatment such as mentoring, role modeling, and social cohesion. Implications are considered for further research on treatment engagement, retention, and other outcomes.     

Training substance abuse treatment staff to care for co-occurring disorders

Although co-occurring disorders have been associated with poorer substance abuse treatment outcomes and higher costs of care, few individuals with co-occurring disorders receive appropriate mental health care. This article describes the design and implementation of an intervention to improve the quality of mental health care provided in outpatient substance abuse treatment programs without requiring new treatment staff. The intervention focuses on individuals with affective and anxiety disorders and consists of three components: training and supervising staff, educating and activating clients, and linking with community resources. We evaluated three treatment programs (one intervention and two comparison) for the first component by having program staff complete both self-administered questionnaires and semistructured interviews. Staff knowledge and attitudes about co-occurring disorders, job satisfaction, and morale all indicated an improvement at the intervention relative to the comparison sites. The evaluation is still under way; results for implementation of the other two components and for outcomes will be reported later.     

A qualitative exploration of individuals' motivators for seeking substance user treatment

Substance abuse continues to greatly impact the US population. The purpose of this study is to improve understanding of the reasons why individuals seek substance user treatment. Qualitative interviews were conducted with 50 men (n?=?25) and women (n?=?25) across eight substance user treatment programs in Durham, North Carolina, in 2010. We identify six motivating themes regarding reasons for seeking treatment and explore how these themes vary by the participants' mode of entry into treatment. Findings provide a holistic understanding of how and why individuals come into treatment that can enhance the quality and impact of substance user services.     

Coping with AIDS: strategies for patients and staff in drug abuse treatment programs

HIV infection creates difficulties for patients and staff in drug abuse treatment programs. This article reviews significant problems and coping strategies, drawing on experience in a drug abuse treatment program where a third of the patients are HIV infected. Patient-related problems include denial, anger, depression, and isolation. The coping strategies that patients use can exacerbate their illness. Effective coping strategies may involve the development of mutual-support groups and public education. Staff-related problems include the fear of infection, protecting confidentiality, the need to develop new treatment goals, and recognizing the limitations of drug abuse treatment. To lessen the fears of infection, programs can exercise clear body substance precautions, conduct frequent inservice training, and hold periodic updates for staff. To adequately protect confidentiality, programs can keep up with rapidly changing laws and guidelines. To modify treatment goals, programs can alter admission standards for HIV-infected patients, change treatment methods to minimize the impact of occasional relapses, develop medical referral networks, and give special consideration to counselors who treat HIV-infected patients. To cope with the limitations of drug abuse treatment, programs can support counseling staff in coping with emotionally stressful clinical problems and to avoid burnout.     

Residential volatile substance misuse treatment for indigenous youth in Canada

The Youth Solvent Addiction Program (YSAP) was established in 1996 in response to the misuse of volatile substances among First Nations and Inuit youth in Canada. This article outlines the role of Indigenous culture and its intersection with Western approaches to recovery in YSAP's operation of nine residential treatment centers for youth. Treatment practices and client outcome data are used to illustrate YSAP's approach. Limitations of the article are noted.     

Introduction: new directions for vocational rehabilitation in substance user treatment: rebuilding damaged lives

If an important objective of addiction treatment is to increase patient employment, then it makes sense to locate vocational assistance within treatment programs. The purpose of this special issue is to present new research on the improvement of vocational services in addiction treatment. The volume begins with a critical review and synthesis of three decades of research on the effectiveness of specialized vocational services for addiction treatment patients. The new evaluation studies in this volume break down into those conducted in methadone treatment vs. other types of treatment settings. The volume concludes with a framework for evaluating the cost-effectiveness of vocational rehabilitation within addiction treatment. Critical issues that need resolution in this field are identified.     

Phytoestrogens: pharmacological and therapeutic perspectives

Phytoestrogens exert different estrogen receptor-dependent and -independent pharmacological actions. They share with estrogens several structural features and show greater affinity for the newly described estrogen receptor-beta. Many hope that phytoestrogens can exert the cardioprotective, anti-osteoporotic and other beneficial effects of the estrogens used in hormone replacement therapy in postmenopausal women without adversely affecting the risk of thrombosis and the incidence of breast and uterine cancers. Although there are many positive indications that phytoestrogens can fulfil this role, it remains to be proven: controlled interventional studies are lacking, and many questions remain unanswered. This review analyzes, on the basis of available experimental and epidemiological studies, the pros and cons of phytoestrogen use and describes the potential tissue targets and mechanisms of action of phytoestrogens.     

Constructive conflict and staff consensus in substance abuse treatment

Previous studies demonstrated the relationship between consensus among both staff and clients with client engagement in treatment and between client consensus and 1-year treatment outcomes. The present article explores the correlates of staff consensus, defined as the level of agreement among staff as to the importance of treatment activities in their program, using a national sample of 80 residential substance abuse treatment programs. Constructive conflict resolution had the largest effect on consensus. Low client-to-staff ratios, staff education, and staff experience in substance abuse treatment were also significantly related to consensus. Frequency of training, an expected correlate of consensus, was negatively associated with consensus, whereas frequency of supervision was not a significant correlate. The implications of the findings for future research and program improvement are discussed.     

Screening for sexually transmitted infections in substance abuse treatment programs

OBJECTIVES: We evaluated the prevalence of the sexually transmitted infections (STIs) chlamydia and gonorrhea in clients at a methadone maintenance program and a residential detoxification program. METHODS: We collected urine specimens for chlamydia and gonorrhea ligase chain reaction testing and assessed sexual, substance abuse and STI histories. RESULTS: Of 700 subject assessments, 490 occurred among detoxification clients and 210 in methadone maintenance. Chlamydia trachomatis was detected in 5/700 (0.9, 95% CI=0.1-1.8%) and Neisseria gonorrhoeae in none. All chlamydia infected subjects were recruited from the detoxification program. Subjects reported high risk sexual behavior: 17% reported commercial sex exchange, and 22% reported inconsistent condom use with multiple sexual partners during the prior 2 months. CONCLUSION: Based on prevalence in Boston, MA, universal screening for STI in substance abuse treatments programs is not warranted. However, routine screening for younger substance abusers and in communities with high prevalence should be considered.     

Residential Substance User Treatment Programs as Venues for HCV Pharmacological Treatment: Client and Staff Perspectives

Hepatitis C virus (HCV) infection is highly prevalent among drug users. While there are antiviral medications available to combat the virus, the medication regimen is quite arduous, presenting special issues for drug users. We examined the challenges and benefits of using residential substance user treatment programs as venues for clients to undergo HCV medication regimens. Analyses of qualitative data collected from clients and staff in 2003 at four residential substance user treatment programs in the U.S. indicate that challenges primarily include issues involving the medications' side effects, and both financial and communication concerns. Benefits especially involve clients' feelings that they are being proactive in addressing health issues in an environment that provides much-needed support. Findings illuminate the complex issues involved for both clients and the programs, and some steps that programs can take to better support HCV-infected clients regarding HCV medication concerns.     

Building culturally sensitive substance use prevention and treatment programs for transgendered populations

Studies show that transgendered individuals are at high risk for substance use problems. It is important to identify the unique needs and concerns of these individuals and culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse treatment services. This involves incorporating the needs of services from the perspectives of both the transgendered community and health-care professionals. It is the purpose of this article to discuss transgenderism as well as the substance use problems and difficulties within substance use treatment that transgendered men and women may face. This article presents guidelines for the design and evaluation of health-care services to transgendered populations.